Prognosis After Observing the Action of the Remedy by James Tyler Kent
After a prescription has been made the physician commences to make observations. The whole future of the patient may depend upon the conclusions that the physician arrives at from these observations, for his action depends very much upon his observations, and upon his action depends the good of the patient.
If he is not conversant with the import of what he sees, he will undertake to do wrong things, he will make wrong prescriptions, he will change his medicines and do things to detriment of the patient. There is absolutely but one way, and nothing can take the place of intelligence.
If you talk with a great many physicians concerning the observations you have made after giving the remedy you will find that the majority of them have only whims or notions on this subject and see nothing after the prescription is made.
These observations I am going to give you have grown out of much watchfulness, long waiting and watching. If the homoeopathic physician is not an accurate observer, his observation will be indefinite; and if his observations are indefinite, his prescribing is indefinite.
It is taken for granted after a prescription has been made, and it is an accurate prescription, that it has acted. Now, if a medicine is acting it commences immediately to affect changes in the patient, and these changes are shown by signs and symptoms.
The inner nature of the disease appears to the physician through the symptoms, and it is like watching the hands upon the clock. This watching and waiting and observing has to be done by the physician in order that he may judge by the changes what to do, and what not to do. It is true that the homoeopath is not long in doubt in many instances what not to do.
There is always an index that tells him what not to do. If he is sharp and vigilant observer, he will see the index for every case. Of course, if a prescription is not related to the case, if it is a prescription that effects no changes, it does not take long to see that to do; much patient waiting for a foolish prescription is but loss of time, and that should be taken into account among the observations. The observations taken after a specific remedy has been given sufficiently related to the case to cause changes in the symptoms are those of value.
The changes are beginning, what are they like, what do they mean, to what do they amount? The physician must know what he listens to the reports of the patient what is going on. The remedy is known to act by the changing of the symptoms. The disappearance of symptoms, the increase of symptoms, the amelioration of symptoms, the order of the symptoms, are all changes from the remedy, and these changes are to be studied.
Among the commonest things that remedies do is to aggravate or ameliorate. The aggravation is of two kinds; we may have an aggravation which is an aggravation of the disease, in which the patient is growing worse, or we may have an aggravation of the symptoms, in which the patient is growing better.
An aggravation of the disease means that the patient is growing weaker, the symptoms are growing stronger, but the homoeopathic aggravation, which is the aggravation of the symptoms of the patient while the patient is growing better, is something that the physician observes after a true homoeopathic prescription. The true homoeopathic aggravation, I say, is when the symptoms are worse, but the patient says, “I feel better.”
We must now go into the particulars concerning these states, as to the time and place, as to how the aggravation occurs, as to how the amelioration occurs, as to duration, etc. The aggravations and amelioration, the directions of symptoms and many other things have to come up, and be observed and judgment has to be passed upon them.
First of all, the patient should be the aim of the physician, his whole idea should be centred upon the patient to determine whether he is improving or declining. We have to judge by the symptoms to know that this is taking place. Very often the patient will say, “I am growing weaker,” and yet you may know that what he says is not true; so certainly can you rely upon the symptoms and their story, which is more faithful than the patient’s opinion. Many times the patient will say, “Doctor I am growing much worse;” and yet you examine into his symptoms and you find that he is really doing well. Just the moment the he finds out that you are encouraged, he feels better and rouses up and wants to eat.
By the symptoms, also, you can tell when the patient is really weaker, and if the symptoms are taking an inward rather than an outward course you will know, even if he is encouraged, that there is no encouragement for him. We have in the symptoms that which we can rely upon. In the old school we have nothing but the information of the patient. This is of little account after making a homoeopathic prescription. The symptoms themselves must be corroborated. The patient’s opinion must be corroborated by the symptoms. The symptoms do corroborate what the patients say in many instances, but the symptoms are the physician’s most satisfactory evidence.
Another general remark needs to be made, namely, that we should know by the symptoms if the changes occurring are sufficiently interior. If the changes that are occurring are exterior, the physician must be acquainted with the meaning of them, so that he will know by that whether the disease is being healed from the innermost or whether the symptoms have merely changed according to their superficial nature.
Incurable diseases will very often be palliated by mild medicines that act only superficially, act upon the sensorium, act upon the senses, and, though the hidden and deep-seated trouble goes on and progresses, and is sometimes made worse, yet the patient is made comfortable. So that by the symptoms we can know whether the changes that are occurring are of sufficient depth, so that the patient may recover. The direction that the symptoms are taking is sufficient to tell that, especially in chronic disease.
A patient walks into the clinic, somewhat stoop-shouldered, with a hacking cough that he has had for a good many years. You judge by his looks that he has been sick a good while; his face is sickly, he is lean and anxious, he is careworn, he is suffering from poverty and poor clothing and scanty food. Now, you examine all his symptoms, and they clearly indicate that he needs an antipsoric, for the symptoms are covered by an antipsoric, and from the history of the case you know he has needed it a good while.
Upon prolonged examination, the antipsoric you have in mind is strengthened. You now examine his chest, and discover he has not the expansion that he ought to have, and you detect the presence of tuberculosis, and by feeble pulse and many other corroborating symptoms you ascertain that the patient has been steadily declining.
You give the medicine and he comes back in a few days with quite a sharp aggravation of the symptoms; he has an increased cough, he has a night sweat, and he is more feeble. Now, the homoeopathic physician likes to hear that; he likes to hear of an exacerbation of the symptoms; but this patient comes back in a week, and the aggravation is still present, and is somewhat on the increase, the patient is coughing worse, and the expectoration is more troublesome than ever, his night sweats have been going on; he comes back at the end of the second week and he is still worse, and all the symptoms have been worse since he took that medicine. He was comparatively comfortable before he took that medicine, but at the end of the fourth week he is steadily growing worse. There has been no amelioration following this aggravation, and he is evidently declining; he now cannot come to the office for he is so weak.
This, then, will be the first observation-a prolonged aggravation and final decline of the patient. What have we done? It has been a mistake, the antipsoric was too deep, it has established destruction. In this state the vital reaction was impossible, he was incurable case. The question immediately comes up, what are you to do? Are you not going to give the homoeopathic remedy in such cases? The patient steadily declines. If you are in doubt about such action of the remedies and making the patient worse, you will probably have an undertaker’s certificate to sign before long.
In incurable and doubtful cases give no higher than the 30th or 200th potency, and observe whether the aggravation is going to be too deep or too prolonged. There are many signs in the chest in such cases to make a physician doubt whether he will give a deep remedy when organic disease is present. Of course this does not apply when things are only threatening, when you have fear of their coming, but when you are sure of their being present. In the instance given the probability is that the remedy has been too late, and it has attempted to arouse his economy, but turned to destruction his whole organism. Then begin, in such cases, with a moderately low potency, and the 30th is low enough for anybody or anything.
When the patient does not seem to be quite so bad as the one I have just described, you get him a little earlier in his history before the trouble has gone quite so far, and then if you administer this same very high potency in the same way you will make a second observation. Though the aggravation is long and severe, yet you have a final reaction, or amelioration. The aggravation lasts for many weeks, perhaps, and then his feeble economy seems to react, and there is a slow but sure improvement.
It shows that the disease has not progressed quite so far; the changes have not become quite so marked. At the end of three months he is prepared for another dose of medicine, and you see a repetition of the same thing, and you may know then that that man was on the border land and had he gone further, cure would have been impossible. It is always well in doubtful cases to go to the lower potencies, and in this way go cautiously prepared to antidote the medicine if it takes the wrong course.
Then the second observation is, the long aggravation, but final and slow improvement. If, at the end of a few weeks, he is a little better and his symptoms are a little better than when he took the dose, there is some hope that finally the symptoms may have an outward manifestation whereby he will attain final recovery, but for many years you may go along with prolonged aggravations. You will find in such a patient there was the beginning of some very marked tissue change in some organ. We may know by observing the action of a remedy what state the tissues are in, as well as know something about the prognosis for the patient.
The third observation After administering the homoeopathic remedy is, where the aggravation is quick, short and strong with rapid improvement of the patient. Whenever you find an aggravation comes quickly, is short, and has been more or less vigorous, then you will find improvement of the patient will be long. Improvement will be marked, the reaction of the economy is vigorous, and there is no tendency to any structural change in the vital organs.
Any structural change that may be present will be found on the surface, in organs that are not vital; abscesses will form and often glands that can be done without will suppurate in regions that are not important to the life of the patient. Such organic changes are surface changes, and are not like the changes that take place in the liver, in the kidneys, in the heart and in the brain. Make a difference in your mind between organic changes that take place in the organs that are vital, that carry on the work of the economy, and organic changes that take place in structures of the body that are not essential to life. An aggravation quick, short and strong is one that is to be wished for and is followed by quick improvement. Such is the slight aggravation of the symptoms that occurs in the first hours after the remedy in an acute sickness, or during the first few days in a chronic case.
Under the fourth observation, you will notice a class of cases wherein you will find very satisfactory cures, where the administration of the remedy is followed by no aggravation whatsoever. There is no organic disease, and no tendency to organic disease. The chronic condition itself to which the remedy is suitable is not of great depth, belongs to the functions of nerves rather than to threatened changes in tissues. You must realize that there are changes in tissues so marked that the vital force is disturbed in flowing through the economy, and yet so slight that man with all of his instruments of precision cannot observe them. Under such circumstances we may have sharp sufferings, but cures may come about without any aggravation. We know then that if there is no aggravation the potency just exactly fitted the case, but here you have a course of things that you need not always expect. Though there is nothing but a true nervous change in the economy after a potency that is not suitable, either too crude, or too high, for that patient, you will have an aggravated state of the symptoms. In cures without any aggravation we know that the potency is suitable, and the remedy, the curative remedy, provided that the symptoms go off and the patient returns to health in an orderly way. It is the highest order of cure in acute affections, yet the physician sometimes will be more satisfied if in the beginning of his prescribing he notices a slight aggravation of the symptoms. The fourth observation then relates to cases in which we have no aggravation, with recovery of patient.
The amelioration comes first and the aggravation comes afterwards is the fifth observation. At times you will see sickly patients, fully as sick as the one I mentioned in the first or second instance, walk into your office and after long study you administer a remedy. The patient comes back in a few days telling you how much better he was immediately after taking the medicine, and now he has three or four days of what appears to be decided improvement, a prompt action of the remedy. The patient says he is better, and the symptoms seem to be better; but wait, and at the end of a week or four or five days all the symptoms are worse than when he first came to you. It is not a very uncommon thing in severe cases, in cases of a good many symptoms, to have an amelioration of the remedy come at once; but whatever you may say, the condition is unfavorable.
Either the remedy was only a superficial remedy, and could only act as a palliative, or the patient was incurable and the remedy was somewhat suitable. One of these two conclusions must be arrived at, and this can only be done by a re-examination of the patient and by finding out whether the symptoms relate to that remedy. Sometimes you will discover that the remedy was an error; a further study of the case shows that the remedy was only similar to the most grievous symptoms, that it did not cover the whole case, that it did not affect the constitutional state of the patient, and then you will see that the patient is an incurable one and the selection was an unfavorable one. It is the best thing for the patient if the symptoms come back exactly as they were, but very often they come back changed, and then you must wait through grievous suffering for the picture; and the patient will wait better if the doctor confesses on the spot that the selection was not what it ought to be, and he has to do better next time. It is a strange thing how the patients will have an increase of confidence if the doctor will tell the truth. The acknowledgment of one’s own ignorance begets confidence in an intelligent patient.
The higher and highest potencies will act in curable cases a long time. When I say act, I only speak from appearance; I should say they appear to act a long time, for the remedy acts at once and establishes a condition of order upon the patient, after which there is no use in giving medicine. This order will continue a considerable length of time, sometimes several months. The patient will get along just as well without any medicine, and get along better with out that medicine that helped him than with it. In curable cases, whose prospects are good, they will go along for a long time, and become very much relieved of their symptoms. Now, if the patient comes back at the end of the first, second and third week and says he has done well, that he has been improving all the time from the cm. of Sulphur, but at the end of the fourth week he comes back and says, “I have been running down,” the physician must then pass judgment. Has this patient done something to spoil the action of this medicine? Has he been on a drink? Has he handled chemicals? Has he been in the fumes of Ammonia? No, he has done none of these things.
This condition is really an unfavorable one. To have a medicine act but a few weeks, whereas it ought to act for months thereafter, will make you suspicious of that patient. If nothing has taken place to interfere with this medicine in his economy you may be suspicious of this case. This sixth observation is too short relief of symptoms. The relief after the constitutional remedy does not last long enough, does not last as long as it ought to. If you examine the third observation you find that there you have the quick aggravation followed by long amelioration; but in this, the sixth, you have the amelioration, but of too short duration. In instances where you have an aggravation immediately after, and then a quick rebound, you will never see, absolutely never see, too short an action of that remedy; or, in other words too short an amelioration of the remedy. If there is a quick rebound that amelioration should last; if it does not last, it is because of some condition that interferes with the action of the remedy; it may be unconscious on the part of the patient, or it may be intentional. A quick rebound means everything in the remedy, means that it is well chosen, that the vital economy is in a good state, and if everything goes well, recovery take place.
In acute cases we may see this too short amelioration of the symptoms; for instance, a dose of medicine given in a most violent inflammation of the brain may remove all the symptoms for an hour, and the remedy have to be repeated, and at the end of that repetition we find only an amelioration of thirty minutes. You may make up your mind, then, that that patient is in a desperate condition, it is too short an amelioration. The action of Belladonna in some very acute red-faced conditions is instantaneous. In five minutes I have noticed the amelioration come, but the best kind of an amelioration is that which comes gradually at the end of an hour or two hours, as it is likely to remain. If it is too short an amelioration in acute cases, it is because such high grade inflammatory action is present that organs are threatened by the rapid processes going on. It is too short amelioration in chronic diseases, it means that they are structural changes and organs are destroyed or being destroyed or in a very precarious condition. These changes cannot always be diagnosed in life, but they are present, and an acute observer, who has been working earnestly for years, will often be able to diagnose the meaning of symptoms without any physical examination whatever, so that he can prophesy as to the patient. Such experiences of an intelligent physician in a family will cause them to look upon him as wiser than anyone else, for he knows all about their constitutions. This he acquires by studying their symptoms, the action of remedies upon them, and their symptoms after the medicines have been given. This enables him to know the reaction of a given patient, whether slow or quick, and how remedies affect each member of that family. This belongs to the physician, and he should be intelligent enough to know something about them when he has been treating them a little while. The old physician is in possession of this knowledge, while the student and the new physician have it all to learn.
Once in a while you will seen a full time amelioration of the symptoms, yet no special relief of the patient, which is the seventh observation. There are certain patient that only gain about so much there are latent conditions, or latent existing organic conditions, in such patients that prevent improvement beyond a certain stage. A patient with one kidney can only improve to a certain degree; patient with fibrinous structural change in certain places, tubercles that have become encysted and lungs capable of doing only limited work, will have symptoms, and these symptoms will be ameliorated from time to time with remedies, but the patient is only curable to a certain extent; he cannot go beyond and rise above such a state. Remember this after several medicines have been administered, and the amelioration of the case has existed often the full length of time of the remedies, but the patient has not risen above his own pitch in this length of time. The remedies act favorably, but the patient is not cured, and never can be cured. The patient is palliated in this instance, and it is a suitable palliation for homoeopathic remedies.
Observation eight. Some patients prove every remedy they get; patients inclined to be hysterical, overwrought, oversensitive to all things. The patient is said to have an idiosyncrasy to everything, and these oversensitive patients are often incurable. You administer a dose of a high potency, and they will go on and prove that medicine, and while under the influence of that medicine they are not under the influence of anything else. It takes possession of them, and acts as a disease does; the remedy has its prodromal period, its period of progress and its period of decline.
Such patients are provers, they will prove the highest potencies. When you find a patient that proves everything you give in the higher potencies go back to the 30th and 200th potencies. Such patients are most annoying. You will often cure their acute diseases by giving them the 30th and 200th, and you will relieve their chronic disease by giving them the 30th, 200th and 500th potencies. Many of them are born with this sensitivity and they will die with it; they are not capable of rising above this over-irritable and over-wrought state. Such oversensitive patients are very useful to the homoeopathic physician. After they get out of one proving they are quite ready to repeat it or go into another.
The ninth observation is the action of the medicines upon provers. Healthy provers are always benefited by provings, if they are properly conducted. It is well to observe carefully the constitutional states of an individual about to become a prover, and to write these down and subtract them from the proving. These symptoms will not very commonly appear during the proving; if they do, note the change in them.
The tenth observation relates to new symptoms appearing after the remedy. If a great number of new symptoms appear after the administration of a remedy, the prescription will generally prove an unfavorable one. Now and then the coming of a new symptom will simply be an old symptom coming up that the patient has not observed, and thinks it a new one. The greater the array of new symptoms coming out after the administration of a remedy, the more doubt there is thrown upon the prescription. The probability is, after these new symptoms have passed away, the patient will settle down to the original state and no improvement take place. It did not sustain a true homoeopathic relation.
The eleventh observation is when old symptoms are observed to reappear. In proportion as old symptoms that have long been away return just in that proportion the disease is curable. They have only disappeared because newer ones have come up. It is quite a common thing for old symptoms to appear after the aggravation has come, and hence we see the symptoms disappearing in the reverse order of their coming. Those symptoms that are present subside, and old symptoms keep coming up. The physician must know himself that the patient is on the road to recovery, and it is well to say to the patient that this is encouraging; that diseases get well from above downwards, etc. Old symptoms often come back and go off without any change of medicine. It indicates that the medicine must be let alone. If the old symptoms come back to stay then a repetition of the dose is often necessary.
The twelfth observation. We will notice sometimes that symptoms take the wrong direction. For instance, if you prescribe for a rheumatism of the knees or feet, or for a rheumatism of the hands, and relief takes place at once in the rheumatism of the extremities, but the patient is taken down with violent internal distress that settles in the region of the heart, or centres in the spine, you see at once a transference has taken place from circumference to centre, and the remedy must be antidoted at once, otherwise structural change will take place in that new site. When diseases go from centre to circumference, going out from the centres of life, out from the heart, lungs, brain and spine, out from the interiors, upon the extremities, it is well. So it is that we find most gouty patients get along best when their fingers and toes are in the worst condition. To prescribe for this, and see the heart symptoms grow worse is a most uncomfortable state of affairs, for it is attended with a gradual downward tendency. Eruptions upon the skin and affections in the extremities are good signs. I remember one time I was discharged from a violent old woman with quite a considerable amount of Billingsgate, who told me that when she called me in she could walk about, and now her ankles were swelled up with rheumatism so that she could not move. That patient got another doctor, but soon died. There is a great danger in selecting a remedy on external symptoms alone, i.e., selecting a remedy that corresponds only to the skin and ignoring all the symptoms that the patient may have, ignoring the whole economy and general state of the patient; because it is true that that remedy that is related to the skin alone may drive in that skin disease and cause it to appear while the patient himself is not cured. Such a patient will remain sick until that eruption comes back again, or locates in another place.